Number of Uninsured Up, but Health Care Law Has Helped & Will Help Further Starting in 2014, Commonwealth Fund Reports

Percentage of Uninsured Young and Adults 2012 (graphic by Commonwealth Fund)In a new report issued on Friday, the nonprofit Commonwealth Fund reported the results of its 2012 biennial survey on the number of U.S. adults who lacked health insurance or were underinsured.

The total number of uninsured adults over age 19 increased by about 3 Million from 2010 to 2012 (before full implementation of the health care law), but the number of young adults uninsured declined by about 3.4 Million due to the health care law, the report found.

The new data “underscore why it is critical that implementation [of the health care law, the Patient Protection & Affordable Care Act (which some call 'Obamacare'] continue on schedule,” the Commonwealth Fund concludes in its report.

Number of Uninsured Age 19 and Over Has Increased by 3 Million Since 2010

The report, entitled “Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act,” finds that the overall number of adults uninsured or underinsured had increased to an estimated 84 million in 2012, which is 3 million more than in 2010 when the Patient Protection & Affordable Care Act was signed into law, and 20 million more than in 2003.

“Nearly half (46%) of adults ages 19 to 64, or an estimated 84 million people, did not have insurance for the full year or were underinsured and unprotected from high out-of-pocket costs. Two of five (41%) adults, or 75 million people, reported they had problems paying their medical bills or were paying off medical debt. And more than two of five (43%), or 80 million people, reported cost-related problems getting needed health care,” the report states.

But, Number of Uninsured Young Adults Has Declined by 3.4 Million Since 2010 Thanks to Affordable Care Act

However, the report also finds that the number of uninsured young adults has significantly decreased, due to the increased health insurance coverage under their parents’ policies afforded to them by the provisions of the Affordable Care Act that have already gone into effect.

“..[N]early 8 of 10 (79%) young adults reported that they were insured at the time of the survey in 2012, up from 69 percent in 2010, or a gain in health insurance coverage for an estimated 3.4 million young adults,” the Commonwealth survey found. “This marks an abrupt reversal in a decade-long upward climb in the number of uninsured young adults, one that is most likely the result of the Affordable Care Act’s requirement that children under age 26 be permitted to stay in or join a parent’s health plan,” the report states.

“Meanwhile, uninsured rates for other age groups increased or stayed the same.”

The Poor Suffer a Disproportionate Share of the Burden of Being Uninsured or Underinsured

“Three-quarters of working-age adults with incomes under 133 percent of the federal poverty level ($14,856 for an individual or $30,657 for a family of four)—an estimated 40 million people—either experienced a time without health insurance or were underinsured in 2012,” according to the new Commonwealth Fund report.

“Among adults earning between 133 percent and 249 percent of poverty ($27,925 for an individual or $57,625 for a family of four), 59 percent, or an estimated 21 million people, had a time without coverage or were underinsured. People with incomes under 250 percent of poverty comprised 72 percent of the total number of Americans who were uninsured or poorly insured in 2012,” the report states.

Many Struggling to Pay Medical Bills – Whether Insured or Not

“Gaps in health insurance, inadequate coverage, and large medical bills leave millions of U.S. adults burdened with debt,” the Commonwealth Fund reported. “In 2012, more than two of five (41%) adults ages 19 to 64, or 75 million people, reported problems paying their medical bills or said they were paying off medical debt over time,” the report stats. “Of those who reported difficulties paying medical bills or paying off medical debt, 42 percent (32 million people) said they received a lower credit rating as result of unpaid medical bills.”

However, “While the number of adults reporting medical bills or debt problems climbed in the past decade, the number was statistically unchanged between 2010 and 2012.” “This is likely because there was some improvement in the coverage of young adults, but either no improvement or a deterioration in coverage for older age groups,” the report concludes.

Meanwhile, the largest economic burden, again, is falling disproportionately on those with lower incomes. According to a graphic on “The Price of being uninsured” released by the Commonwealth Fund, 15% of all Americans spent 10% or more of their incomes on health insurance premiums in 2012. However, fully 36% of those with incomes below $30,657 per year (for a family of four in 2012) spent 10% or more of their incomes on health insurance premiums. This contrasts with only 4% of those with incomes of $92,200 or more.

The States Show Varying Percentages of Uninsured and Those Struggling to Pay Medical Bills

Percentage of Adults Uninsured during all or part of 2012 in CA, NY, FL, TX (grahpic by Commonwealth Fund) - Click to EnlargeIn a blog post published concurrently with the new report on Friday, April 26, the Commonwealth Fund indicated that “For the first time, the Commonwealth Fund supplemented its national survey results with state-specific data for the nation’s four largest states: California, Florida, New York, and Texas.”

These data showed that the percentages of uninsured and underinsured in the States of Texas and Florida were higher than the national average, while the percentages of uninsured and underinsured in California and New York were lower than the national average. The graph at right, published with the blog post, illustrates the findings.

In addition, adults in Florida and Texas had greater difficulties paying their medical bills, and higher numbers reported foregoing needed medical care in those States because of inability to pay for the care.

“Nearly half (48%) of Floridians [compared to 41% of all Americans nationally] reported they had difficulty paying medical bills or were paying off accrued medical debt—the highest rate across the four states. This was 14 percentage points higher than the share of adults reporting these problems in California, where 34 percent had medical bill problems or debt―the lowest rate reported among these four states,” the report states.

The report also found that Florida had the highest rate of adults who reported foregoing needed care because of the cost, “with fully half (51%) of adult residents saying they had not gotten care for that reason.”

And, “nearly half of adults in both New York (48%) and Florida (47%) pointed to financial reasons for avoiding health care,” the report stated.

The Insurance Reforms of the Patient Protection & Affordable Care Act (“Obamacare”), Which Kick In Starting in 2014 Will Help

“The major insurance coverage provisions of the Affordable Care Act go into effect in January 2014, providing new insurance options for people without health insurance and insurance market protections for consumers,” the introductory paragraph of the Commonwealth Fund report states. The findings of its new survey and report “underscore why it is critical that implementation continue on schedule,” the Commonwealth Fund states.

“The Affordable Care Act has already helped millions of young adults gain or maintain health insurance, banned carriers from placing limits on what they will pay and from cancelling policies retroactively because of illness, and improved the reliability of health insurance purchased in the individual market. Indeed, those protections may be partly responsible for the slowing rate of growth in underinsured adults over the past two years,” the report states.

“But it is imperative for federal and state policymakers to complete the rollout of the law’s central coverage provisions,” the Commonwealth Fund asserts.

“These [provisions of the health care law that will go into effect in 2014] include expanded eligibility for Medicaid and for subsidized comprehensive insurance plans made available through the new insurance marketplaces. These changes will be reinforced with sweeping insurance market reforms, including banning insurers from charging people higher premiums based on health or gender or limiting or denying benefits because of preexisting health conditions, among others.”

In its blog post published on April 26, the Commonwealth Fund stated that “The open enrollment period for the Affordable Care Act’s new insurance coverage options begins this October in all 50 states.”

“People without health insurance, or those who are inadequately insured, will be able to visit a health insurance marketplace to find out if they are eligible for help. This includes new subsidies to cover the cost of a private health plan sold through the marketplace, available to people earning up to about $92,000 for a family of four, as well as a newly expanded Medicaid program for people with incomes up to about $31,000 for a family of four.”

Under the law, the States can either set up and run their own insurance marketplaces or choose to participate in a federally operated marketplace. So far, California and New York have elected to operate their own insurance marketplaces. Florida and Texas, among other states, have elected to participate in federally operated marketplaces.

“Of the estimated 55 million adults who had a gap in coverage in 2012, 87 percent had incomes that would make them eligible for subsidized health insurance under the law,” the report states.

“Twenty-eight million had incomes below 133 percent of the poverty level, making them eligible for Medicaid, and 20 million had incomes between 133 percent and 399 percent of poverty, making them eligible for subsidized health plans,” according to the report.

“In addition, of the 30 million adults who were underinsured in 2012, 85 percent had incomes that could make them eligible for Medicaid or subsidized health plans, with reduced out-of-pocket spending.”

“[T]he law does not provide subsidized coverage to people who are not in the U.S. legally,” the report points out.

“More people insured and better-quality coverage will likely lead to less medical cost–fueled debt and fewer cost-related access problems,” the Commonwealth Fund concludes.

The Availability of Expanded Medicaid Coverage Will Depend Upon What State You Live In, Due to the Supreme Court’s Ruling

States Participating in Medicaid Expansion under Affordable Care Act as of April, 2013 (graphic by Commonwealth Fund) - Click to EnlargeHowever, the report also points out that the Supreme Court’s ruling upholding the Affordable Care Act potentially weakened the expanded Medicaid coverage provisions in the law, by making them voluntary to the states. According to the report, even though under the law, the Federal Government will fund 100% of the costs of the expanded Medicaid coverage until 2016, as of April 2013, “About 25 states are either undecided or have decided not to participate in the expansion.”

The Commonwealth Fund’s map at left shows, as of April 2013, the states that have opted to participate in the Medicaid expansion so far (shown in blue), those that have agreed to participate with a variation in the program negotiated with the Federal Government (shown in dotted blue), those that are undecided (shown in light blue), and those that have officially opted not to participate in the Medicaid expansion (in white).

This means that for those with incomes at or under 133% of the poverty level, who could be eligible for the expanded Medicaid Coverage under the health care law, whether they receive the intended help will depend on what State they happen to live in, due to the Supreme Court’s ruling.

More Information

The Commonwealth Fund’s Full Report, “Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act,” is available online on the Fund’s website.

For more news and information about the Patient Protection & Affordable Care Act, President Obama’s signature Health Care Law, and about health care reform, see the HelpingYouCare® resource pages on VoicesForCare™, including:


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